Academician Evgeniy Nikolaevich Meshalkin (1916–1997) (on the 105th anniversary of his birth)

The outstanding cardiologist and cardiac surgeon Evgeny Nikolaevich Meshalkin was born on February 25, 1916 in the city of Yekaterinoslav, now Dnepropetrovsk. In 1918, the Meshalkin family moved to Rostov-on-Don, and in 1928 to Moscow, where Evgeny graduated from school in 1930, and then studied at the factory school at the Sickle and Hammer factory. In 1941, Evgeny Nikolaevich graduated from the 2nd Moscow Medical Institute and from August 1941 to May 1945 was a participant of the Great Patriotic War permanently in the field army. After demobilization from the army, E. N. Meshalkin worked from 1946 to 1956 at the department and at the clinic of Faculty Surgery of the 2nd Moscow State Medical Institute, headed by Academician of the USSR Academy of Medical Sciences A. N. Bakulev. In 1950, he defended his PhD thesis «Intubation anesthesia», and in 1953, his first monograph «Intubation anesthesia Technique» was published. Evgeny Nikolaevich is rightfully considered one of the founders of the Russian anesthesiology. In 1953, E. N. Meshalkin defended his doctoral dissertation «Probing and contrast study of the heart and major vessels». In conditions of moderate nonperfusion hypothermia, Yevgeny Nikolaevich successfully operated on complex heart defects, performed the insertion of mechanical prostheses for mitral and aortic insufficiency. From January 1956 to 1960, he was the head of the Department of Thoracic Surgery and Anesthesiology of the Central Institute of Advanced Medical Training (now the Russian Medical Academy of Postgraduate Education). E.N.Meshalkin owns 47 copyright certificates and patents, which are implemented not only in the Research Institute of Circulatory Pathology, but also in other cardiac surgery centers in Russia. Honorary citizen of Novosibirsk Evgeny Nikolaevich Meshalkin passed away on March 8, 1997 and was buried in Novosibirsk at the Southern Cemetery. In memory of the outstanding scientist, the Novosibirsk Research Institute of Circulatory Pathology was named after Academician E. N. Meshalkin.

Possibilities of non-operative and minimally invasive organ-preserving spleen injuries management in blunt abdominal injuries in adults

The Objective was to assess and improve the treatment results of victims with spleen injury in blunt abdominal trauma by using high-tech minimally invasive methods of diagnosis and treatment.Methods and materials. The article analyzed the results of treatment of 86 patients with isolated and combined blunt spleen injuries who received conventional surgery, and 52 similar patients who were treated in accordance with the new algorithm. This algorithm included conventional splenectomy for unstable hemodynamics and non-operative and minimally invasive management for stable hemodynamics after MSCT. In the absence of CT signs of ongoing bleeding, non-operative management was performed, if ongoing bleeding signs were detected, angiography with selective angioembolization was performed.Results. In both groups, most of the victims with blunt spleen injury were admitted to the trauma center after traffic accidents and catatraumas. There were no statistically significant differences in the injury severity (ISS, Tsibin scales), and the condition severity (VPH-SP). The tactics of non-operative and minimally invasive management was applied in 31 patients of the prospective group with stable hemodynamics. Non-operative management was performed on 16 patients of the prospective group. Four patients of this group underwent angiography and selective embolization of the branches of the splenic artery. In the retrospective group, there was a greater number of local complications compared to the prospective group (p=0.006). The decrease in the number of visceral and generalized complications was statistically insignificant (p>0.05). In the retrospective group, 21 victims died. Of these, 12 patients died from severe combined trauma and massive blood loss during the first 24 hours. In the prospective group, the total number of deaths was 10 patients. Of these, 6 died from polytrauma with acute massive blood loss, 1 – from severe traumatic brain injury, 1 – from PE, 2 – from sepsis. In the prospective group, among the patients with stable hemodynamics who had conservative treatment of abdominal trauma, 2 deaths were observed in the long-term period due to severe traumatic brain injury and PE.Conclusion. Organ-preserving management was carried out in 26 of 52 (50 %) patients, the number of performed diagnostic laparocenteses was reduced by 50.6 %, laparoscopies – by 16.5 %, laparotomies – by 60.7 %, the duration of inpatient treatment of surviving patients was more than for 7 days, mortality – by 5.2 %.

Topographic, anatomical and clinical rationale of the optimal minimally invasive technique of parathyroidectomy

Introduction. The information presented in the literature on the use of minimally invasive interventions in the treatment of hyperparathyroidism is not fully justified by topographical and anatomical studies and does not take into account individual features of the location and syntopia of the parathyroid glands, which requires additional scientific research.Objective.Based on the topographical and anatomical features of the structure of the anterior neck region, we determined the most rational methods of minimally invasive interventions on the parathyroid glands and evaluated their clinical effectiveness in patients with hyperparathyroidism.Methods and materials. The design of the study consisted of two stages – topographical and anatomical, and clinical. Topographical and anatomical stage was performed on 2 levels: 1) on anatomical material, which included 15 human cadavers; 2) on plastinated cross sections of the neck (n=44) of human cadavers. During the clinical stage, we studied results of examination and treatment of 53 patients with hyperparathyroidism, who underwent surgery using three methods: Сonventional (n=18/34 %); Minimally Invasive Video-Assisted Parathyroidectomy (n=32/60 %) and Transoral Endoscopic Parathyroidectomy Vestibular Approach (n=3/6 %).Results. During the topographical and anatomical stage, the validity and safety of minimally invasive video-assisted parathyroidectomy was proved. The use of this access in clinical practice as an alternative to the conventional one has shown its effectiveness in reducing the frequency of specific postoperative complications from 16.7 to 6.3 % with an acceptable increase in the duration of surgery from (42.8±15.7) to (64.4±23.5) minutes and maintaining the average duration of inpatient treatment after surgery at the level of (3.4±0.6) days.Conclusion. Minimally invasive video-assisted parathyroidectomy can be considered the operation of choice in the treatment of patients with hyperparathyroidism. The use of this technique with the implementation of lateralization of the thyroid lobe, the preservation of the superior and inferior thyroid vessels, as well as the use of intraoperative neuromonitoring and identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid can improve the results of surgical treatment, reduce the number of postoperative complications, the frequency of persistence and relapse of the disease, and improve the quality of life of patients.

Evaluation of the effectiveness of negative pressure wound therapy in the complex treatment of patients with infected mesh endoprostheses of the anterior abdominal wall

Introduction. Wound complications after the placing of various implants of the abdominal wall after hernia repair account for up to 15 % of all hospitalizations with purulent diseases. Their treatment is often accompanied by a high frequency of explantation of a mesh endoprosthesis with a risk of recurrent hernias in this category of patients.The objective of the study was to improve the results of surgical treatment of patients with infected implants of the abdominal wall after herniaplasty based on the assessment of the effectiveness of the negative pressure wound therapy (NPWT).Methods and materials. A retrospective analysis of the treatment results of patients with infected mesh endoprostheses of the anterior abdominal wall (n=68) was carried out. We formed for comparison two homogeneous representative groups of patients, who underwent adequate debridement of a purulent wound with empirical antibiotic therapy. Patients from the study group (n=38) received local therapy using NPWT, patients from the control group (n=30) received traditional local therapy. The evaluation of the treatment results was carried out according to a number of criteria: the course of the systemic inflammatory reaction, the dynamics of reparative processes in the wound of the anterior abdominal wall, evaluation of the clinical outcomes of treatment of patients.Results. The use of vacuum therapy was accompanied by a positive effect on the course of the systemic inflammatory reaction, stimulation of reparative processes in the wound due to the rapid elimination of bacterial agents from the wound cavity (p= 0.003), as well as significant retraction of the wound cavity (p=0.004) compared to traditional methods of wound treatment. Patients from the study group had more favorable treatment outcomes such as a reduction in the duration of hospitalization (p=0.005) and the number of surgical interventions (p=0.003). Due to the NPWT, it was possible to save implants in 30 patients out of 38 (78.9%) with infected mesh endoprostheses of the anterior abdominal wall, which prevented the formation of recurrent hernias and helped to avoid reoperations in this category of patients.Conclusion. The use NPWT is a safe and effective method for treating wounds of the anterior abdominal wall with infected mesh endoprostheses after hernioplasty.

Endoprosthesis replacement of the thoracic aorta for traumatic dissection and pseudoaneurysm

Aortic injury in closed chest trauma takes the second place in the structure of mortality in closed injuries. The type of aortic injury is a crucial factor in determining the optimal timing of the operation. For many years, the treatment strategy was reduced to immediate surgical intervention. The mortality rate in open operations is still high. The widespread introduction of endovascular technologies and aortic endoprosthetics has significantly reduced mortality and reduced the number of severe postoperative complications. With the advent of new endoprostheses, the possibilities of treatment have increased even more and its results have improved for various aortic injuries. A case of successful treatment of a patient with traumatic dissection and pseudoaneurysm of the thoracic aorta by endoprosthetics is presented.

Multidisciplinary approach to the treatment of a patient with the consequences of severe traumatic brain injury and tracheoesophageal fistula

An overview of the clinical observation of a patient with the consequences of severe traumatic brain injury, with a tracheoesophageal fistula is presented. The article discusses a staged multidisciplinary approach to treatment.

Common errors in the treatment of patients with malignant bone tumors

This study was aimed to analyze the most common diagnostic and therapeutic errors in orthopaedic oncological diseases. Bone tumors usually do not have characteristic symptoms, especially in the early stages of disease development. Therefore, they can often mimic benign tumors and non-tumor diseases. Careful history taking, detailed clinical and X-ray examinations in a timely manner are essential diagnostic tools for patients with bone sarcomas. Moreover, a correct analysis of clinical and radiological findings with regard to the dynamic relationship between them can help make more accurate diagnosis at the first doctor’s visit. Subsequent X-ray examinations performed in oncological centers using special methods such as spiral CТ, MRI, PET/CT with mandatory morphological verification of the diagnosis enable us to make a more precise diagnosis and to provide an objective assessment of pathological processes. The most common diagnostic and therapeutic errors that occur in orthopaedic oncological diseases were analyzed. In 35 % of cases, diagnostic or tactical errors were made by general practitioners. In 15 % of cases, the errors were associated with a latent course of disease and 12 % of cases were wrongly diagnosed as a benign neoplasm.

Replacement of an extensive chest wall defect in combination with the elimination of postoperative ventral hernia after combined treatment of breast cancer complicated by osteomyelitis of the sternum and ribs

Plastic replacement of osteochondral defect of the chest wall after surgical treatment of osteomyelitis of the sternum and ribs is a complex and topical issue in surgery. Often, an extensive post-resected defect of the sternum and ribs is combined with instability of the frame of the chest wall and thoracoabdominal hernia, which leads to physiological and socio-psychological maladaptation of the patient. The case of successful replacement of an extensive chest wall defect in combination with a ventral hernia in a patient after combined treatment of breast cancer complicated by osteomyelitis of the sternum and ribs is presented. TiNi- reinforcing rib prostheses and TiNi-mesh were used to create the frame of the chest wall and hernioplasty. 5-year follow-up did not reveal a recurrence of osteomyelitis and ventral hernia, implant displacement and instability of the frame of the chest wall. The method of reconstruction of an extensive thoracoabdominal defect using bioadaptive implants from TiNi is safe and effective in patients at the final stage of surgical treatment of osteomyelitis of the chest wall including in combination with ventral hernia. Thanks to the developed technology, an excellent functional result was achieved.

Forms of sternal reconstruction in oncology

INTRODUCTION. Chest wall tumors represent a variety of morphological forms and variants of lesions. According to different authors, primary malignant tumors of the chest wall account for 0.2–2 % of all malignant neoplasms. Of them, soft tissue sarcomas constitute about 45 %. Metastatic tumors of the chest wall occur much more frequently and most commonly develop from malignant tumors of the mammary, prostate and thyroid glands, lungs, kidneys and ovaries.MATERIALS AND METHODS. The standard of the treatment of primary and metastatic tumors of the chest wall is combination or comprehensive therapy. In some cases, preoperative care allows to create a more favorable environment for performing surgical treatment being considered the best option for chest wall tumors. The choice of a technique for the replacement of the post-resection chest wall defect is of special importance to preserve the physiological chest volume, to restore chest rigidity, to prevent paradoxical respiration and to seal the pleural cavity.RESULTS. There are different surgical techniques for skeleton reconstruction. A wide range of materials used for a skeleton reconstruction include bone tissues obtained from patient’s own body (bone autoplasty, autografts), polymeric mesh (polypropylene, polytetrafluoroethylene (Gore-Tex), bone cement (polymethyl methacrylate), stainless steel and titanium constructions as well as titanium bars and rib clips (STRATOS). In spite of a large number of techniques for sternal reconstruction described in the literature, searching for new materials and ways of their usage appears relevant.CONCLUSION. Our clinical case studies demonstrate that modern reconstructive techniques combined with careful surgical planning allow to perform radical surgery with a successful outcome preventing serious postoperative complications.

Review of the practical manual for physicians «Mediastinitis» by M. M. Abakumov (Moscow, MK, 2020: 296. (In Russ.))

A review of the manual for physicians «Mediastinitis» published in 2020, written by the famous Russian surgeon and scientist Professor Mikhail Mikhailovich Abakumov, is presented. The manual is based on the study of pathogenesis and practical experience in the diagnosis and treatment of patients with various forms of mediastinitis at the Sklifosovsky Research Institute for Emergency Medicine for 40 years. Sections of the manual include the history of the problem, terminology and classification issues, pathogenesis, clinical presentation and diagnosis, surgery and postoperative treatment of mediastinitis. The manual is intended for a wide range of surgeons who may be involved in acute mediastinitis diagnosis and treatment.